Proof of Service PersonalCal. Super. - 6th Dist.March 11, 2020»-'--+- - Complete-and sign this form, and Proof of Service Use this form to serve a person, a business, or a public entity. To learn more about proofofservice, read What]: ”ProofofSendceW, Form SC-104B. To learn more about how to serve a business or entity, read How to Serve a Business 0r Public Emily, Form SC-104C. To serve a business, you must serve one of the following people: - Owner (for a sole proprietorship) . ° Panner (for a partnership) or general panner (for a limited pannership) - Any officer 0r general manager (corporation or association) - Any person authorized for service by the business (corporation, association, general partnership, limited partnership) ' Any person authorized for service with the Secretary ofState (corporation, association, limited liability company [LLC], limited liability partnership [LLP], limited partnership) To serve a public entity, you must first file a claim with that entity, then serlefinepfjhefollowing people: ~ H- Clerk (ofa city or county) ° Chiefofficer or director (ofa public agency) - Any person authorized for service by the entity G) a. If you are serving a person, write the person’s name below: mambo 1,0961 b. Ifylou are sewing a business or entity, wfite the name ofthe business or entity, the person authorized for service, aqd that person’s job title: .MENJA5 m; 11712446 Business or Agency Name Person Authorized for Service Job Title Instructions to Server: Clerk stamps dale here when form is filed‘ ILE MAR 2 3 2020 Fill in court name alflslreM address: Superior CounMalifornia, County of Superior Coun-Civil Division 191 N. First St. San Jose. CA 95113 Fill in case number, case name, hearing dale, day, lime, and deparfmen! below: Case Number: 208ny2 875’ Case Name: Hearing Date: q'Z7’zD Time: /_w;p Dept.: /y You must be at least 18 years old and not be named in this case. Follow these steps: - Give a copy ofall the documents checked in© to the person in ®, 0r ° Give a copy of all the documents checked in© to one ofthe following people: a. A competent adult (at least 18) living with, and at the home of the person in , 0r b. An adult (at least 18) who seems to be in charge at the usual workplace ofthe person in G), or c. An adult (at least 18) who seems to be in charge where the person in® usually receives mail (but not a U.S. Post Office box), if there is no known physical address for the person in®. and mail a copy ofthe documents left with one of the adults in a, b, or c above to the person in®. THEN ~ Give or mail your completed fon‘n to the person who asked you to serve these court papers, in timefar theform to befiled with the court at least 5 days before the hearing. G) lserved the person in (D a copy of the documents checked below: a. ‘ SC-lOO, Plaintiflk Claim and ORDER t0 Go to Small Claims Court b. D SC-l20, Defendant's Claim and ORDER t0 G0 to Small Claims Court 8W3} c. D Order for examination (Thisform must be personally served. Check thefonn that was served): Note: The court can issue a civil arrest warrant iflhe servedparty does not come to court only ifthe orderfor aramin‘ation was personally served by a registered process server, sherlfl marshal, or someone appointed by the court. (1) D SC- 1 34, Application and Order to Produce Statement ofAssets and to Appearfor Examination (2) D AT-138/EJ-125, Application and Orderfor Appearance and Examination d. D Other (speczfi); Judicial Couna'l of California. www.coum‘nlo.m‘gov Revised January 1, 2009, Optional Form Cude olCivil Procedure. §§ 116340. 415.10. 4‘5‘20 Proof of Service (Small Claims) SC-104, Page 1 of 29 Case Number: Case name: ® Fill out “a” or “b” below: a. D Personal Service: I per onally gave copies of the documents checked in© to the person in ®: On (date);4W At (time): _§_£m____ D 1m, Mpm At this address: (/40 n (/07 b. D Substituted Service: Ipersonally gave copies ofthe documents checked in® (a, b, or d) to (check one): D A competent adult (at least 18) at the home of, and living with the person in® , or D An adult who seems t0 be in charge where the person in® usually works, or D An adult who seems t0 be in charge where the person in® usually receives mail, or has a private post office box (not a U.S. Post Office box), ifthere is n_<_), known physical address for the person in®. "’“ “I‘tBIH’tkfit‘a‘dfilt‘, "Please give tHese_court papers to (name 0f person in®." [did this 0n (date): At (time): D a.m. D pm. At this address: ! City: State: Zip; ' Name or description of the person I gave the papers to: After sewing the court papers, I put copies ofthe documents listed in® in an envelope, sealed the envelope, and put first-class prepaid postage on it. 1 addressed the envelope to the person in G) at the address where I left the copies. I mailed the envelope on (date):_________from (city, state): by leaving it (check one): a. D At a U.S. Postal Service mail drop, or b. D At an office 0r business mail drop where I know the mail is picked up every day and deposited with the U.S. Postal Service, or QB With someone else I asked to mail the documents to the person in ®, and I have attached that person’s completed Form SC-104A. ® Server’s Informatiop Namei QLOM A Arm ‘1}wa Phone: KID 8 9V0 é 23 7 Address: [(187 W577 mfg_uM___ __ W_ _ v _ _ _~_- _ a City? W U737; State: m Zip: 9“ 3/ Fee for service: $ Ifyou are a registered process server: COUDW 0f l’eEiStFationi Registration numbér: © I declare under penalty of pexjury under California state law that I am at least 18 years old and not named in this case and that t e in ormation above is true and correct. Date: 3 I 1 20 , goété “hrR/bfl D Mug, ”/mM Type or print server ’3 name Server signs here after serving Revised January 1.2009 proof of Service SC-104. 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